Environmental Infection Control

ENVIRONMENTAL INFECTION CONTROL DURING CONSTRUCTION AND RENOVATION Presented By: Doug Marshall

Environmental Infection Control

WHAT IS IT? 

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Identifying hazards that could potentially compromise patient care

Implementing proper controls to reduce risk and minimize the impact of hazards created by demolition, renovation, and/or new construction activities

Environmental Infection Control

What is it? (cont.) Impacts may include those on air or water quality, infection control, utility and equipment requirements,

noise and vibration, emergency procedures, etc.

Environmental Infection Control

Why the concern?  Sensitive patients, physically and/or mentally  Compromised immune systems (illness or medication)  Critical medical procedures  Critical services, utilities, and equipment that cannot be

damaged or disrupted  Need for stable indoor environment

Environmental Infection Control

Contaminants of Concern 

Air- Particulates 

Dust

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Microbials

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Gases/Fumes/Odors

Waterborne Contaminants  Misc. Nuisances  Noise/Vibration 

Environmental Infection Control > Contaminants

DUST PARTICULATES 

General Dust

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Demolition/Dismantling

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Sanding/Cutting

Environmental Infection Control > Contaminants

Microbial Particulates 

Microbial “reservoirs” in flooring, wall cavities, HVAC systems, materials affected by water damage or high humidity, or spores brought in from outdoors

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May include molds that are pathogenic, toxic, and/or allergenic (especially Aspergillus)

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May include bacterial growth

Environmental Infection Control > Contaminants

Other Contaminants 

Gases/Fumes/Odors

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Welding/Soldering

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Cutting/Grinding

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VOCs- off-gassing of new products, adhesives, etc.

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Chemicals/Cleaners

Environmental Infection Control > Contaminants

Misc. Issues 

Not necessarily environmental contaminants, but potentially disruptive

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Increased foot and vehicle traffic

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Alternate routes of building exit/entry

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Alternate emergency/fire evacuation routes and procedures Abnormal “loads” on utilities or equipment

Environmental Infection Control

Noise & Vibration

May affect patients and/or employees 

premature neonates

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recent ICH or stroke

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neurological/psychiatric disorders

May affect critical procedures/testing 

EEG or EKG

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hearing assessments

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neurological studies

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fine motor skill procedures

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certain laboratory procedures sleep studies, etc.

Environmental Infection Control

Current Regulations & Guidelines  

The Joint Commission (TJC) AIA Guidelines for the Design and Construction of Hospital and Health Care Facilities (mandated by state law)

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CDC Guidelines on Environmental Infection Control

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State Licensure (depending upon state)

Environmental Infection Control > Regulations & Guidelines

TJC Environment of Care Std. 

EC.8.30 

Demolition, Construction or Renovation, and Maintenance

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Proactive risk assessment

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Identify hazards that could potentially compromise patient care

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Address impact on requirements/procedures

Environmental Infection Control > Regulations & Guidelines

EC8.30 CONSTRUCTION, DEMOLITION, AND MAINTENANCE/REPAIR  

Infection Control Risk Assessment (Multi-disciplinary team approach to project review for prevention of airborne & waterborne nosocomial disease.) 

design and function of new area

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At risk patients

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dust and moisture containment

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Noise/vibration

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What contingency plans are in place for unexpected outages

Environmental Infection Control > Regulations & Guidelines

CDC GUIDELINES FOR EIC 

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Construction, Renovation, Remediation, Repair and Demolition ICRA (Infection Control Risk Assessment) 

Multi-disciplinary team

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Risk assessment of project

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P&P to protect patients

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Procedures to correct problems rapidly

Environmental Infection Control > Regulations & Guidelines

CDC GUIDELINES FOR EIC 

CDC Guidelines- Major Air Quality Issues 

Air Sampling

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External and Internal demolition- Are Barriers Required?  Working with plumbing in sensitive areas  Exposure of ceiling spaces  Crawling into ceiling spaces  Work on elevator shafts  Demo of wallboard, plaster, ceramic tile, ceiling tile

Environmental Infection Control > Regulations & Guidelines

CDC GUIDELINES FOR EIC (CONT.) 

Major Air Quality Issues (cont.) 

Removal of flooring

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Removal of windows and doors

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Removal of casework

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HVAC systems design and filtration

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HVAC maintenance and repair  duct cleaning  system shutdown

 moisture in system  backup emergency power

Environmental Infection Control > Regulations & Guidelines

AIA GUIDELINES (CHAPTER 5) 

For all new construction and renovation 

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Consultation from infection control professionals, and safety professionals Development of an ICRA Initiated in planning and design and continued through construction/renovation

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Performed by multi-disciplinary panel

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Documented!!

Environmental Infection Control > Regulations & Guidelines

CHAPTER 5 ICRA- BASIC ELEMENTS Impact of disrupting essential services  Patient placement and relocation  Placement of barriers  Evaluation of ventilation needs  Number of AII and PE rooms  Patient protection from: 

 

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Demolition Un-planned outages Movement of debris Patient flow through building

Environmental Infection Control > Risk Assessment

ICRA MATRIX 

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Aids in determining proper work practices and types of engineering controls, and monitoring required. Assesses risk based upon the patient risk group and types

of activities performed

Environmental Infection Control > Risk Assessment

ICRA Matrix (cont.) 

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Type A- (Inspection and Non-invasive)  removing ceiling tile for inspection  painting without sanding  wall-covering  electrical trim  minor plumbing Type B (Work Activities)  Small scale/ short duration  Minimal dust created

Environmental Infection Control > Risk Assessment

ICRA Matrix (cont.) Type C (Work Activities)  Demolition/removal of fixed building parts  Moderate-high dust, including sanding, flooring removal, ceiling tiles & casework, major cabling,  Can’t be done in 1 shift Type D (Work Activities)  

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Major demolition/construction High dust created, including heavy demo, removal of walls, new construction Required consecutive work shifts

Environmental Infection Control > Engineering Controls

Engineering Controls Containment of Dust and Debris 

Controlling construction related activities

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Envelope penetrations

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Building shafts, chutes, stairwells and elevators

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Removal of materials from building

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Electrical and water system shutdowns

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HVAC system shutdowns, potential for passive ventilation

Environmental Infection Control > Engineering Controls

Common Controls 

Defining contractor points of entry/exit

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Use of tacky mats and disposable suits

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General containment barriers

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Control cubes for point of entry

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Negative pressure requirements

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HVAC system protection and isolation

Environmental Infection Control > Engineering Controls

Types of Barriers Short-duration 

Fire-resistant plastic

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Airtight with Negative Pressure

Long Duration 

Install plastic barrier while building rigid barrier

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Drywall on metal studs

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Floor to floor construction

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Seal and tape all joints, edges, holes, etc.

Environmental Infection Control > Engineering Controls

Consider Outside Influences 

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Protect building ventilation systems (i.e. freshair intakes) Control building entrances Window/door infiltration Access to construction zones Building tie-ins Street cleaning Emergency response

Environmental Infection Control

Monitoring 

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Establish background bio-aerosol levels prior to construction Compare levels during and after construction to these baselines

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Include viable and non-viable particles

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Monitor ventilation (air changes, filtration, pressure)

Environmental Infection Control > Monitoring

When Should You Sample? Baseline and before occupancy (“Commissioning”) 

Insure proper ventilation and cleanliness

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Provides comparison data for later if necessary

Ongoing Surveillance 

Pressure differentials

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Air Exchanges

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Particle count for filtration efficiency

Environmental Infection Control

Understand Air Flow in the Building 

Positive vs. Negative Pressure

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Air Flow Velocities

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Affects of doors and window

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Elevator shafts

Environmental Infection Control

OVERALL GOALS: 

Save Lives through: 

Changing attitudes toward construction and maintenance

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Use proper techniques even if not the Easiest/cheapest

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Planning ahead

QUESTIONS AND ANSWERS

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